Comments for The Hospitalist Leader

Comment on Where is The Guy from IHI? by jpercelay

jpercelay — Wed, 08 Sep 2010 01:31:03 +0000

I’m a fan of Berwick as well, but hell if I know what is the best approach to take in this political climate. I do think it’s incumbent upon us as physicians to be vocal politically to try to create some reasonable dialog. My fear is that there will be a vocal minority of physicians who will mimic what Fox news has to say, and that reasoned dialog among physicians is as unlikely as is reasonable dialogue among politicians.

Keep up the good work.

Comment on High Plains Drifter, MD by jpercelay

jpercelay — Wed, 08 Sep 2010 01:25:46 +0000

Mike,
Sounds as if things have ended working out well for you. I’ve changed positions a couple of times, sometimes because the family has moved on my initiative, once because a program closed, and other times because of bad fits. For what it’s worth, my take is that I would have been better off being honest with myself at the beginning when the fit is bad and been more adventurous in looking for a new position instead of sticking with the bird in the hand.
Interested to hear what others have to say.

Comment on A Swiss Miss…Or Maybe Not? by Jairy Hunter, MD, MBA, SFHM

Jairy Hunter, MD, MBA, SFHM — Mon, 23 Aug 2010 18:52:36 +0000

Good post. This exact topic (indeed Switzerland was specifically discussed) in a documentary from a couple of years back called “Sick Around the World.” It hit the high (and low) points of the six richest nations’ healthcare systems, including the US, which, by the way, is the only one without some sort of universal coverage. I found it fair and relatively even handed despite being a PBS piece. In those countries, no one goes bankrupt because of health care bills. On the other hand, several of the aforementioned nations’ systems are broke.

Although the challenges are great–the dissemination of misinformation, mis-perception, and even the American Dream notwithstanding–I have come to believe that how we handle the legions of uninsured individuals says a lot about our society.

I am conflicted professionally, however, in that no one with any clout seems to be discussing tort reform which most physicians cite as a reason for escalating costs and defensive practices.

The PBS program can be viewed online here: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

Comment on A Swiss Miss…Or Maybe Not? by steve

steve — Sun, 08 Aug 2010 13:33:35 +0000

I am surprised that right of center health writers would want this kind of system. I would have thought the cost controls unacceptable. They are also currently suing to do away with the individual mandate.

Steve

Comment on SHM and ACO’s: All Systems Slow by Jack Percelay

Jack Percelay — Fri, 30 Jul 2010 01:58:37 +0000

Brad,
Wish I could fault your reasoning. Having trained and worked in Kaiser Northern California 20 years ago, I remain a big believer in the system. And the combined Northern and Southern California systems were certainly much more scalable than the Geisinger system. Certainly Kaiser wasn’t perfect, but it was effective in most areas. Biggest shortfall seemed to be in caring for Medicaid (or, as it’s called in California, Medi-Cal patients); very hard for a healthcare system to cure societies ills. But culture change is the prerequisite to spreading such systems into new areas, and it’s not clear that changing reimbursement paradigms will be sufficient to change the culture.

Comment on SHM and ACO’s: All Systems Slow by Mike

Mike — Thu, 29 Jul 2010 22:22:12 +0000

Great post, Brad.
I worked in a model where we had a lot of capitation thrown in with our medicare and commercial patients. I always felt the push to get the HMO patients out faster. Seemingly, in an ACO or AQC setup (like in MA), there would still be competing systems under one roof. Do you have any thoughts on how to manage a practice which may be in a hybrid state? On one hand favoring productivity (due to favorable commercial patients) on the other favoring QI/cost for the “alternative contracts?” Although they are not mutually exclusive priorities, seems like it would be messy and lend it self to practice variation like in some Orwellian paradigm…some patients more equal than others….

Comment on The Spend We Don’t Have, Part II by Jack Percelay

Jack Percelay — Tue, 15 Jun 2010 16:06:15 +0000

Brad,
Thoughtful as always, as is above comment.

Here’s an interesting way of looking at the issue from the med school supply side.

Fitzhugh Mullan and his team just published “The Social Mission of Medical Education: Ranking the Schools” which includes a metric, called the social mission score, that evaluates medical schools by their output in an adequate number of primary care physicians, adequate distribution of physicians to underserved areas, and a sufficient number of minority physicians in the workforce.

http://www.annals.org/content/152/12/804.full?aimhp

Certainly very applicable to the University of California system where I trained 27 years ago and paid $497 a quarter initially. Tuition actually went down my second year: there was a state budget surplus. Really. Now, it’s hard for me to justify why the taxpayers of the state of California should have subsidized my education to that extent. Or, if they do choose to subsidize medical students’ education, they would seem to have a right to influence the outcome.

Fundamentally, however, I think career choices are more about respect and career satisfaction. But that’s another topic.

Comment on The Spend We Don’t Have, Part II by Fair Pay For Our Doctors

Fair Pay For Our Doctors — Mon, 14 Jun 2010 21:36:18 +0000

[...] week’s Health Wonk Review included an excellent article by Brad Flansbaum at The Hospitalist Leader. Brad’s article discussed the details of physician pay and the [...]

Comment on The Spend We Don’t Have, Part II by A killer edition of Health Wonk Review « Boston Health News

A killer edition of Health Wonk Review « Boston Health News — Thu, 10 Jun 2010 13:38:36 +0000

[...] Flansbaum comments on physician salary and workforce issues in a post entitled The Spend We Don’t Have, Part II at The Hospitalist [...]

Comment on The Spend We Don’t Have, Part II by maggiemahar

maggiemahar — Sat, 05 Jun 2010 20:45:30 +0000

Provocative post.

The charts showing how much physicians earn compared to the average worker in different countries do suggest that we are over-paying specialists

And we know that enormous gaps between those at the top of our income ladder, those in the middle, and those at the bottom de-stablize both the economy and the society.Surveys show that the majority of economists believe that the gaps must be narrowed.

At the same time, the chart showing primary care pay suggests that we may have that about right. We are paying GPs 3.4 times the average wage– putting GP pay in the U.S. close to the very top of the ladder, right behind Iceland (3.5 times average wage.) Insofar as we don’t subsidize med school education, we should be paying more. than other countries . . The question is: how much more?

Median wage for primary care docs in the U.S. is now around $175,000, which means that they earn more than 96% of all Americans.

But median income tends to capture income mid-career. Newly-minted primary care docs may earn as little as $100,000 to $105,000. IF they are carrying $150, 000 in med school loans and living in a city, they are hard-pressed.

Since new money won’t be coming into the system, we are going to have to redistribute health care dollar within the system. This means gradually lowering the incomes of the top-paid specialists., I would suggest that money might best be used subsidize med school education in areas where we have shortages (family docs, internists, gerontologists, palliative care specialists) and so that students can graduate free of loans. This also would allow more students coming from low-income families to go to med school. Most observers agree that we need more diversity in the physician work-force.

In addition, given the years of education required- to become a doctor -and the opportunity cost– starting salaries for GPs probably should be raised to $125,000???

But a median income of $175,000 that puts GPs in the top 4% should be sufficient to make them feel both valued and respected.

The problem today is that GPs compare themselves to radiologists and dermatologists earning $400,000.

Money is always relative.
The “obscene” incomes of some specialists, like obscene CEO salaries, have distorted our sense of what a professional should earn.

Over time, we’ll need to lower those salaries, and raise taxes on he wealthiest 2% to 3%. We can’t do it all at once because it would be far too disruptive. People have created lives that revolve around the assumption that they’ll be earning $500,000. But bit by bit we do need to redistribute those health care dollars.